Clinical Endoscopy

The Korean Society of Gastrointestinal Endoscopy (대한소화기내시경학회)
권호 표지
DOI QR코드

DOI QR Code

No difference in outcomes with 15 mm vs. 20 mm lumen-apposing metal stents for endoscopic ultrasound-guided gastroenterostomy for gastric outlet obstruction: a meta-analysis

  • Shyam Vedantam (Department of Medicine, University of Miami) ;
  • Rahil Shah (Department of Medicine, University of Miami) ;
  • Sean Bhalla (Division of Digestive Health and Liver Diseases, Department of Medicine, University of Miami) ;
  • Shria Kumar (Division of Digestive Health and Liver Diseases, Department of Medicine, University of Miami) ;
  • Sunil Amin (Division of Digestive Health and Liver Diseases, Department of Medicine, University of Miami)
  • Received : 2022.11.12
  • Accepted : 2023.03.10
  • Published : 2023.05.30
Download PDF
⟨ Previous Next ⟩

Abstract

Background/Aims: We compared outcomes between use of 15 vs. 20 mm lumen-apposing metal stents (LAMSs) in endoscopic ultrasound-guided gastroenterostomy (EUS-GE) for gastric outlet obstruction. Methods: Databases were queried for studies that used LAMS for EUS-GE to relieve gastric outlet obstruction, and a proportional meta-analysis was performed. Results: Thirteen studies were included. The 15 mm and 20 mm LAMS had pooled technical success rates of 93.2% (95% confidence interval [CI], 90.5%-95.2%) and 92.1% (95% CI, 68.4%-98.4%), clinical success rates of 88.6% (95% CI, 85.4%-91.1%) and 89.6% (95% CI, 79.0%-95.1%), adverse event rates of 11.4% (95% CI, 8.1%-15.9%) and 14.7% (95% CI, 4.4%-39.1%), and reintervention rates of 10.3% (95% CI, 6.7%-15.4%) and 3.5% (95% CI, 1.6%-7.6%), respectively. Subgroup analysis revealed no significant differences in technical success, clinical success, or adverse event rates. An increased need for reintervention was noted in the 15 mm stent group (pooled odds ratio, 3.59; 95% CI, 1.40-9.18; p=0.008). Conclusions: No differences were observed in the technical, clinical, or adverse event rates between 15 and 20 mm LAMS use in EUS-GE. An increased need for reintervention is possible when using a 15 mm stent compared to when using a 20 mm stent.

Keywords

Acknowledgement

Advice on data analysis was provided by the in-house statistician, Thilani Samarakoon, whose aid was greatly appreciated.

References

  1. Koop AH, Palmer WC, Stancampiano FF. Gastric outlet obstruction: a red flag, potentially manageable. Cleve Clin J Med 2019;86:345-353.  https://doi.org/10.3949/ccjm.86a.18035
  2. Stefanovic S, Draganov PV, Yang D. Endoscopic ultrasound guided gastrojejunostomy for gastric outlet obstruction. World J Gastrointest Surg 2021;13:620-632.  https://doi.org/10.4240/wjgs.v13.i7.620
  3. Potz BA, Miner TJ. Surgical palliation of gastric outlet obstruction in advanced malignancy. World J Gastrointest Surg 2016;8:545-555.  https://doi.org/10.4240/wjgs.v8.i8.545
  4. No JH, Kim SW, Lim CH, et al. Long-term outcome of palliative therapy for gastric outlet obstruction caused by unresectable gastric cancer in patients with good performance status: endoscopic stenting versus surgery. Gastrointest Endosc 2013;78:55-62.  https://doi.org/10.1016/j.gie.2013.01.041
  5. McCarty TR, Garg R, Thompson CC, et al. Efficacy and safety of EUS-guided gastroenterostomy for benign and malignant gastric outlet obstruction: a systematic review and meta-analysis. Endosc Int Open 2019;7:E1474-E1482.  https://doi.org/10.1055/a-0996-8178
  6. Itoi T, Baron TH, Khashab MA, et al. Technical review of endoscopic ultrasonography-guided gastroenterostomy in 2017. Dig Endosc 2017;29:495-502.  https://doi.org/10.1111/den.12794
  7. Hosono S, Ohtani H, Arimoto Y, et al. Endoscopic stenting versus surgical gastroenterostomy for palliation of malignant gastroduodenal obstruction: a meta-analysis. J Gastroenterol 2007;42:283-290.  https://doi.org/10.1007/s00535-006-2003-y
  8. Jeurnink SM, Steyerberg EW, van Hooft JE, et al. Surgical gastrojejunostomy or endoscopic stent placement for the palliation of malignant gastric outlet obstruction (SUSTENT study): a multicenter randomized trial. Gastrointest Endosc 2010;71:490-499.  https://doi.org/10.1016/j.gie.2009.09.042
  9. Jeurnink SM, Steyerberg EW, Hof Gv, et al. Gastrojejunostomy versus stent placement in patients with malignant gastric outlet obstruction: a comparison in 95 patients. J Surg Oncol 2007;96:389-396.  https://doi.org/10.1002/jso.20828
  10. Ge PS, Young JY, Dong W, et al. EUS-guided gastroenterostomy versus enteral stent placement for palliation of malignant gastric outlet obstruction. Surg Endosc 2019;33:3404-3411.  https://doi.org/10.1007/s00464-018-06636-3
  11. Adler DG. Should patients with malignant gastric outlet obstruction receive stents or surgery? Clin Gastroenterol Hepatol 2019;17:1242-1244.  https://doi.org/10.1016/j.cgh.2018.11.049
  12. Troncone E, Fugazza A, Cappello A, et al. Malignant gastric outlet obstruction: which is the best therapeutic option? World J Gastroenterol 2020;26:1847-1860.  https://doi.org/10.3748/wjg.v26.i16.1847
  13. Iqbal U, Khara HS, Hu Y, et al. EUS-guided gastroenterostomy for the management of gastric outlet obstruction: a systematic review and meta-analysis. Endosc Ultrasound 2020;9:16-23.  https://doi.org/10.4103/eus.eus_70_19
  14. Sobani ZA, Paleti S, Rustagi T. Endoscopic ultrasound-guided gastroenterostomy using large-diameter (20 mm) lumen apposing metal stent (LLAMS). Endosc Int Open 2021;9:E895-E900.  https://doi.org/10.1055/a-1399-8442
  15. Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 2009;6:e1000097. 
  16. Wells GA, Shea B, O'Connell D, et al. The Newcastle-Ottawa scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses [Internet]. Ottawa: Ottawa Hospital Research Institute; 2019 [cited 2021 Jul 23]. Available from: http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp. 
  17. ASGE Standards of Practice Committee, Early DS, Acosta RD, et al. Adverse events associated with EUS and EUS with FNA. Gastrointest Endosc 2013;77:839-843.  https://doi.org/10.1016/j.gie.2013.02.018
  18. Tyberg A, Perez-Miranda M, Sanchez-Ocana R, et al. Endoscopic ultrasound-guided gastrojejunostomy with a lumen-apposing metal stent: a multicenter, international experience. Endosc Int Open 2016;4:E276-E281.  https://doi.org/10.1055/s-0042-101789
  19. Itoi T, Ishii K, Ikeuchi N, et al. Prospective evaluation of endoscopic ultrasonography-guided double-balloon-occluded gastrojejunostomy bypass (EPASS) for malignant gastric outlet obstruction. Gut 2016;65:193-195.  https://doi.org/10.1136/gutjnl-2015-310348
  20. Khashab MA, Bukhari M, Baron TH, et al. International multicenter comparative trial of endoscopic ultrasonography-guided gastroenterostomy versus surgical gastrojejunostomy for the treatment of malignant gastric outlet obstruction. Endosc Int Open 2017;5:E275-E281.  https://doi.org/10.1055/s-0043-101695
  21. Perez-Miranda M, Tyberg A, Poletto D, et al. EUS-guided gastrojejunostomy versus laparoscopic gastrojejunostomy: an international collaborative study. J Clin Gastroenterol 2017;51:896-899.  https://doi.org/10.1097/MCG.0000000000000887
  22. Kerdsirichairat T, Yang J, Gutierrez OI, et al. Long-term outcomes of endoscopic ultrasound-guided gastroenterostomy using lumen-apposing metal stents for gastric outlet obstruction: A 4-year cohort. Gastrointest Endosc 2018;87(6S):AB320-AB321.  https://doi.org/10.1016/j.gie.2018.04.1692
  23. Chen YI, Kunda R, Storm AC, et al. EUS-guided gastroenterostomy: a multicenter study comparing the direct and balloon-assisted techniques. Gastrointest Endosc 2018;87:1215-1221.  https://doi.org/10.1016/j.gie.2017.07.030
  24. Kerdsirichairat T, Irani S, Yang J, et al. Durability and long-term outcomes of direct EUS-guided gastroenterostomy using lumen-apposing metal stents for gastric outlet obstruction. Endosc Int Open 2019;7:E144-E150.  https://doi.org/10.1055/a-0799-9939
  25. Bondi G, Bazarbashi AN, Abbas AM, et al. Endoscopic gastroenterostomy versus surgical gastrojejunostomy for the treatment of gastric outlet obstruction in patients with peritoneal carcinomatosis: a retrospective comparative study. Gastrointest Endosc 2020;91(6S):AB303. 
  26. Nguyen NQ, Hamerski CM, Nett A, et al. Endoscopic ultrasound-guided gastroenterostomy using an oroenteric catheter-assisted technique: a retrospective analysis. Endoscopy 2021;53:1246-1249.  https://doi.org/10.1055/a-1392-0904
  27. Bejjani M, Ghandour B, Subtil JC, et al. Clinical and technical outcomes of patients undergoing endoscopic ultrasound-guided gastroenterostomy using 20-mm vs. 15-mm lumen-apposing metal stents. Endoscopy 2022;54:680-687.  https://doi.org/10.1055/a-1654-6914
  28. Xu G, Shen Y, Lv Y, et al. Safety and efficacy of endoscopic ultrasound-guided gastroenterostomy using double balloon occlusion methods: a clinical retrospective study in 36 patients with malignant gastric outlet obstruction. Endosc Int Open 2020;8:E1690-E1697.  https://doi.org/10.1055/a-1221-9656
  29. Madanat L, Saumoy M, Sharaiha RZ. Endoscopic gastrojejunostomy: bigger is better. Endoscopy 2018;50:E331-E332.  https://doi.org/10.1055/a-0640-2630
  30. Tyberg A, Kedia P, Tawadros A, et al. EUS-directed transgastric endoscopic retrograde cholangiopancreatography (EDGE): the first learning curve. J Clin Gastroenterol 2020;54:569-572.  https://doi.org/10.1097/MCG.0000000000001326
  31. Tyberg A, Kats D, Choi A, et al. Endoscopic ultrasound guided gastroenterostomy: what is the learning curve? J Clin Gastroenterol 2021;55:691-693.  https://doi.org/10.1097/MCG.0000000000001400
  32. Tyberg A, Jha K, Shah S, et al. EUS-guided gallbladder drainage: a learning curve modified by technical progress. Endosc Int Open 2020;8:E92-E96.  https://doi.org/10.1055/a-1005-6602
  33. Adler DG, Baron TH. Endoscopic palliation of malignant gastric outlet obstruction using self-expanding metal stents: experience in 36 patients. Am J Gastroenterol 2002;97:72-78. https://doi.org/10.1111/j.1572-0241.2002.05423.x